Patterns of Failure and Impact of Adjuvant Therapy Following Pancreaticoduodenectomy for Ampullary Carcinoma

James Metz, MD
OncoLink Associate Editor
Last Modified: November 3, 1999

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Presenter: Jason H. Lee, MD
Affiliation: University of Pennsylvania

Background:
The prognosis for ampullary carcinoma is somewhat more favorable than pancreatic cancer and other biliary carcinomas. However, aproximately 50% of patients experience a relapse of their disease. The role of adjuvant therapy after radical resection remains unclear. This study was performed to evaluate the outcomes and impact of adjuvant therapy in this patient population. Materials and Methods:

  • 208 patients were identified having had a Whipple Procedure performed at the University of Pennsylvania
  • 39 (19%) of these patients had an ampullary primary cancer
  • All patients in the series underwent a complete resection of disease
  • 51% of patients had the poor prognostic factors of positive lymph nodes or invasion of the pancreas
  • 13 patients (33%) received adjuvant chemoradiation therapy
  • Median dose of radiation was 4860 cGy
  • Chemotherapy was 5-FU based in all patinets
  • Median follow-up was 45 months for surviving patients
Results:
  • 3 year survival was 55%
  • Patients with positive lymph nodes had an overall survival of 29% versus 73% for negative lymph nodes
  • There was no benefit from adjuvant therapy in patents without positive lymph nodes or invasion of the pancreatic head
  • High risk patients appeared to benefit from adjuvant therapy
  • Disease free survival was 52% at 3 years
Clinical/Scientific Implications:
  • Patients with positive lymph nodes or T3 disease had a higher risk of failure
  • Adjuvant chemotherapy and radiation therapy may improve long-term survival
  • The role of adjuvant therapy should be further evaluated in prospective trials

ASTRO coverage is sponsored, in part, by Varian Medical Systems, Inc.


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